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. 2024 Jun 4;19(6):e0298182.
doi: 10.1371/journal.pone.0298182. eCollection 2024.

Investigation of geographic disparities of diabetes-related hospitalizations in Florida using flexible spatial scan statistics: An ecological study

Jennifer Lord  1 , Agricola Odoi  1
Affiliations

Investigation of geographic disparities of diabetes-related hospitalizations in Florida using flexible spatial scan statistics: An ecological study

Jennifer Lord et al. PLoS One. .

Abstract

Background: Hospitalizations due to diabetes complications are potentially preventable with effective management of the condition in the outpatient setting. Diabetes-related hospitalization (DRH) rates can provide valuable information about access, utilization, and efficacy of healthcare services. However, little is known about the local geographic distribution of DRH rates in Florida. Therefore, the objectives of this study were to investigate the geographic distribution of DRH rates at the ZIP code tabulation area (ZCTA) level in Florida, identify significant local clusters of high hospitalization rates, and describe characteristics of ZCTAs within the observed spatial clusters.

Methods: Hospital discharge data from 2016 to 2019 were obtained from the Florida Agency for Health Care Administration through a Data Use Agreement with the Florida Department of Health. Raw and spatial empirical Bayes smoothed DRH rates were computed at the ZCTA level. High-rate DRH clusters were identified using Tango's flexible spatial scan statistic. Choropleth maps were used to display smoothed DRH rates and significant high-rate spatial clusters. Demographic, socioeconomic, and healthcare-related characteristics of cluster and non-cluster ZCTAs were compared using the Wilcoxon rank sum test for continuous variables and Chi-square test for categorical variables.

Results: There was a total of 554,133 diabetes-related hospitalizations during the study period. The statewide DRH rate was 8.5 per 1,000 person-years, but smoothed rates at the ZCTA level ranged from 0 to 101.9. A total of 24 significant high-rate spatial clusters were identified. High-rate clusters had a higher percentage of rural ZCTAs (60.9%) than non-cluster ZCTAs (41.8%). The median percent of non-Hispanic Black residents was significantly (p < 0.0001) higher in cluster ZCTAs than in non-cluster ZCTAs. Populations of cluster ZCTAs also had significantly (p < 0.0001) lower median income and educational attainment, and higher levels of unemployment and poverty compared to the rest of the state. In addition, median percent of the population with health insurance coverage and number of primary care physicians per capita were significantly (p < 0.0001) lower in cluster ZCTAs than in non-cluster ZCTAs.

Conclusions: This study identified geographic disparities of DRH rates at the ZCTA level in Florida. The identification of high-rate DRH clusters provides useful information to guide resource allocation such that communities with the highest burdens are prioritized to reduce the observed disparities. Future research will investigate determinants of hospitalization rates to inform public health planning, resource allocation and interventions.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Urban-rural classification of ZIP code tabulation areas and geographic distribution of counties and major cities in Florida, USA.
Figure is not copyrighted and was created by study authors using non-proprietary open-source software, QGIS.
Fig 2
Fig 2. Geographic distribution of spatial empirical Bayes smoothed diabetes-related hospitalization (DRH) rates at the ZIP code tabulation area level in Florida, 2016–2019.
Figure is not copyrighted and was created by study authors using non-proprietary open-source software, QGIS.
Fig 3
Fig 3. Geographic distribution of spatial empirical Bayes smoothed diabetes-related hospitalization (DRH) rates in selected metropolitan areas in Florida, 2016–2019.
Figure is not copyrighted and was created by study authors using non-proprietary open-source software, QGIS.
Fig 4
Fig 4. Significant high-rate spatial clusters of diabetes-related hospitalizations at the ZIP code tabulation area level in Florida, 2016–2019.
Figure is not copyrighted and was created by study authors using non-proprietary open-source software, QGIS.
Fig 5
Fig 5. Significant high-rate spatial clusters of diabetes-related hospitalizations in selected metropolitan areas in Florida, 2016–2019.
Figure is not copyrighted and was created by study authors using non-proprietary open-source software, QGIS.
See this image and copyright information in PMC

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